Canada Health Act: Proposed Reorganization, Part III

Synergistic Benefits of this reform

1) Each physician-partnership which acts as a primary insurer answers the Supreme Court’s concern that patients, when faced with inequities in the distribution of care, should have access to an independent source of health care. Independent physician-partnerships obviate the need for government to introduce private health insurance companies. In turn, this eliminates the possible introduction of an ancillary profit motive which would siphon funds away from the delivery of health care.

2) The creation of multiple physician-partnerships with overlapping territories of responsibility will foster real competition within the medical marketplace. These physician-partnerships will find it advantageous to subcontract for services which are either too expensive to develop or to rare to justify maintaining the necessary level of expertise. The partnership would then negotiate a price with a center or organization which is capable of delivering the desired service. These contractual arrangements would shift constantly as science evolves. As an area of expertise becomes more commonplace partnerships may choose to build this service capability “in house.” The sale of specific services such as cardiac or orthopedic surgery would represent a more stable source of competition. A well run physician-partnership program will take advantage of these numerous levels of productive competition within the health-care system. Such competition was identified as a national objective by the Standing Senate Committee on Social Affairs, Science and Technology.

3) Funding for university centers would undergo a period of fiscal evolution.

a) Government grants for research and teaching would continue.

b) Revenue from the sale of specific areas of expertise to physician-partnerships would provide a stable and predictable level of income each year. Cardiac surgery, advanced cancer care, genetic or immunologic services are all possible examples of academic programs which would be marketable to physician-partnerships.

c) University hospitals would also make arrangements to provide blocks of beds to physician-partnerships for local community use. This arrangement would perpetuate traditional relationships between academic and community-based physicians at the level of every day care.

d) Income would also be generated from outside patients attracted by the reputation of the institution or its physicians.

e) Patients who choose to continue to receive their health care through the regional councils would form another block of patient care related income available to university centers.

4) To grow the reputation of their partnership, physicians would make it a priority to eliminate the current waiting time for procedures in Canada. The initial focus of any group would be to achieve this goal.

5) Current disputes between government and the profession over the scope of practice would dissipate. To provide efficient comprehensive care each partnership will need to evaluate the advisability of using physician extenders. As partnerships begin to develop problem based approaches to community care the rational for use of ancillary personnel will become more obvious.

6) The introduction of new technologies will be facilitated by the development of joint ventures which combine the expertise of businessmen, scientists, and the physician community. It will then become possible to spread the investment cost of these ventures over the full spectrum of the health-care economy.

7) Under this reform the sale of secondary policies by physician- partnerships is an important adjunct to the system. This would allow individuals to pre-purchase access to private beds in hospital or to self select access to non contracted sources of care (point of service) for an additional fee. The physician-partnerships could also offer to cover services which the tax-preserved access policy does not cover (e.g. eyeglasses). As long as these policies do not sell priority access to services (i.e. cat scans, etc) then this would not obviate the principle of equal access to all citizens. Such ancillary policies would provide a source of revenue to the health-care system over and above the standard tax preserved levels of income. This would serve to strengthen the fiscal viability of the total system.

8) By accepting this approach to health-care reform Canada will create an open, freely competitive medical marketplace that is modulated at arms length. The underlying principle in this reform is to appropriately align the profit motive throughout the health-care system. Under these conditions government intervention only becomes necessary when the tax-preserved access level needs to be adjusted. Because of the many checks and balances in place the need for more funds will be clearly defined. Both government and the people will recognize the necessity for more funds and accept the increase based upon mutual recognition and consent.

9) Competition between physician-partnerships will foster the elimination of redundancy, the efficient incorporation of valuable new technologies, and the deployment of models for the delivery of care geared toward better outcomes. Freed from government restraint, healthcare will become an equal player in the nation’s economy. The needs of patients will be directly converted into market demand. Gains from cost containment will be reinvested toward the betterment of care. The absence of any external profit motive will drive this model toward fiscal integrity and clinical excellence.

End of Part III